MODERN KIDS DENTISTRY OF ELIZABETHTOWN, PLLC (NPI# 1285299149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285299149 |
| Entity Type | Organization |
| Organization Name | MODERN KIDS DENTISTRY OF ELIZABETHTOWN, PLLC |
| Practice Address |
151 Drexler Cir # A Elizabethtown KY 42701-7843 |
| Mailing Address |
Po Box 23293 Lexington KY 40523-3293 |
| Practice Telephone | 8596081579 |
| Mailing Telephone | 8593217051 |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-05-07 |
| Authorized Official Name | DR. JUSTIN MICHAEL RAYBOULD (OWNER/MANAGER) |
| Authorized Official Telephone | 8593217051 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100342680 | 05 |
| Street Address |
151 DREXLER CIR # A |
| City | ELIZABETHTOWN |
| State | KY |
| Zip Code | 42701-7843 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693104 | James G. Thornton | Specialist/Technologist, Other | 2409 Ring Road, Suite 106, Elizabethtown, KY 42701 | 2020-09-11 |
| 1033720727 | Rebecca Williams | Pharmacist | 1602 N Dixie Highway, Elizabethtown, KY 42701 | 2020-08-14 |
| 1245855709 | Mckenzie Jo Clemons | Speech-Language Pathologist | 107 Financial Drive, Elizabethtown, KY 42701 | 2020-06-10 |
| 1215565825 | Christina Nichole Hobson | Peer Specialist | 413 E Dixie Ste 106, Elizabethtown, KY 42701 | 2020-03-30 |
| 1336701275 | Cassandra Elizabeth Baker | Nurse Practitioner | 2005 N. Dixie Highway, Elizabethtown, KY 42701 | 2019-07-01 |
| 1487134276 | Ryan Leon Hogan | Marriage & Family Therapist | 1106 Tunnel Hill Road, Suite 100, Elizabethtown, KY 42701 | 2018-08-21 |
| 1033623921 | Kayla Russell | Behavior Technician | 529 Westport Road, Elizabethtown, KY 42701 | 2017-11-30 |
| 1578087128 | Brenda Gale Nunn | Case Manager/Care Coordinator | 2600 Ring Road, Elizabethtown, KY 42701 | 2017-07-26 |
| 1013451277 | Chelsea Danielle Thorn | Nurse Practitioner | 2005 N. Dixie Hwy, Elizabethtown, KY 42701 | 2016-12-07 |
| 1003364597 | Joseph Michael Senay | Pharmacist | 521 Robinbrooke Dr., Cancer Care Center of Hardin Memorial Hospital, Elizabethtown, KY 42701 | 2016-09-14 |
| Find all providers in zip 42701 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225484173 | Beenash Anwer | Dentist | 103 Financial Pl Ste 200, Elizabethtown, KY 42701-4470 | 2016-05-10 |
| 1518169820 | Rana Lynn Mathias | Dentist | 420 E Park St, Elizabethtown, PA 17022-2267 | 2007-05-31 |
| 1942290713 | Nicholas C. Murphy | Dentist | 1107 Crown Pointe Dr, Elizabethtown, KY 42701-7123 | 2005-10-24 |
| 1346230240 | Marianne Mills Sheroan | Dentist | 1107 Crowne Pointe Business Center, Suite F, Elizabethtown, KY 42701 | 2005-10-24 |
| 1659910792 | Elizabethtown Pediatric Dentistry | Dentist | 103 Financial Pl Ste 200, Elizabethtown, KY 42701-4470 | 2020-01-06 |
| 1518140698 | Nicholas C. Murphy, Dmd, Psc | Dentist | 1107 Crown Pointe Dr, Suite F, Elizabethtown, KY 42701-7123 | 2007-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518599802 | Derby City Pediatric Dentistry, Pllc | Dentist | 2120 High Wickham Pl Ste 103, Louisville, KY 40245-5903 | 2020-02-05 |
| 1588204655 | Kids Dentistree of Ky LLC | Dentist | 8727 Old Bardstown Rd, Louisville, KY 40291-4490 | 2020-01-07 |
| 1033775374 | Alex Mayes Young Dmd Pllc | Dentist | 7400 Us 42, Florence, KY 41042-1906 | 2019-05-13 |
| 1780141580 | Morgan Marie Nowery | Dentist | 134 Gillette Ave, Louisville, KY 40214-1914 | 2019-02-27 |
| 1578030995 | Huda Hussain Alkuhl | Dentist | 501 S Preston St Fl 3, Louisville, KY 40202-1701 | 2018-10-24 |
| 1073099792 | Lake Cumberland Pediatric Dentistry | Dentist | 100 Hardin Ln Ste A, Somerset, KY 42503-3812 | 2018-07-16 |
| 1376032557 | Devon Cooper | Dentist | 5495 N Bend Rd Ste 102, Burlington, KY 41005-9378 | 2018-05-03 |
| 1609363795 | Alexandria Gene Maxson | Dentist | 1275 Hallwood Dr, Morehead, KY 40351-7370 | 2018-04-16 |
| 1831606094 | Djr2 Professional Limited Liability Company | Dentist | 303 S 4th St Ste 201, Danville, KY 40422-2091 | 2018-01-09 |
| 1083144265 | Kelly Wessel | Dentist | 4413 Santa Paula Ln, Louisville, KY 40219-3820 | 2017-06-19 |
| Find all providers with the same taxonomy | ||||
| City | ELIZABETHTOWN |
| Zip Code | 42701 |
Please comment or provide details below to improve the information on MODERN KIDS DENTISTRY OF ELIZABETHTOWN, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.